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ACROMEGALY
• Acromegaly results from excess secretion of growth hormone (GH).
• Manifestations include enlargement of hands and feet, thickening and enlargement of face
and head bony and soft tissue, sleep apnea, signs of diabetes mellitus, cardiomegaly, and
hypertension.
• Treatment focuses on returning GH levels to normal through surgery, radiation, and drug
therapy. The prognosis depends on age at onset, age when treatment is initiated, and tumor
size.
• Nursing care for surgical patients postoperatively includes avoidance of vigorous coughing,
sneezing, and straining at stool to prevent cerebrospinal fluid leakage from where the sella
turcica was entered.
• After surgery with a transsphenoidal approach, the head of the bed is elevated to a 30-degree
angle at all times, and neurologic status is monitored. Mild analgesia is used for headaches,
and toothbrushing is avoided for at least 10 days.
HYPOPITUITARISM
• Hypopituitarism is rare, and involves a decrease in one or more of the pituitary
hormones:
o The anterior pituitary gland secretes adrenocorticotrophic hormone (ACTH),
thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH),
luteinizing hormone (LH), GH, and prolactin.
o The posterior pituitary gland secretes ADH and oxytocin.
DIABETES INSIPIDUS
• Diabetes insipidus (DI) is associated with deficiency of production or secretion of
ADH or decreased renal response to ADH.
• Decreases in ADH cause fluid and electrolyte imbalances due to increased urinary
output and increased plasma osmolality.
• Types of DI include:
o Central DI (or neurogenic DI) occurs when an organic lesion of the hypothalamus,
infundibular stem, or posterior pituitary interferes with ADH synthesis, transport, or
release.
o Nephrogenic DI occurs when there is adequate ADH, but a decreased kidney
response to ADH. Lithium is a common cause of drug-induced nephrogenic DI.
Hypokalemia and hypercalcemia may also lead to nephrogenic DI.
o Psychogenic DI is associated with excessive water intake, caused by lesion in thirst
center or by psychosis.
• If oral fluid intake cannot keep up with urinary losses, severe fluid volume deficit results as
manifested by weight loss, constipation, poor tissue turgor, hypotension, and shock.
• Nursing care includes early detection, maintenance of adequate hydration, and patient
teaching for long-term management.
GOITER
• Goiter is thyroid gland hypertrophy and enlargement caused by excess TSH stimulation,
which can be caused by inadequate circulating thyroid hormones.
• TSH and T4 levels are measured to determine if goiter is associated with hyperthyroidism,
hypothyroidism, or normal thyroid function.
• Benign nodules are usually not dangerous, but can cause tracheal compression if they
become too large.
• A major sign of thyroid cancer is presence of hard, painless nodule or nodules on enlarged
thyroid gland.
• Nursing care for thyroid tumors is similar to care for patient who has undergone
thyroidectomy.
THYROIDITIS
• Thyroiditis is an inflammatory process in the thyroid gland.
• Subacute and acute forms of thyroiditis have abrupt onset, and the thyroid gland is painful.
HYPERTHYROIDISM
• Hyperthyroidism is thyroid gland hyperactivity with sustained increase in synthesis and
release of thyroid hormones.
• Other causes include toxic nodular goiter, thyroiditis, exogenous iodine excess, pituitary
tumors, and thyroid cancer.
Graves’ Disease
• Graves’ disease is an autoimmune disease marked by diffuse thyroid enlargement and
excessive thyroid hormone secretion.
• Factors such as insufficient iodine supply, infection, and stressful life events may interact
with genetic factors to cause Graves’ disease.
• When thyroid gland is large, a goiter may be noted, and auscultation of thyroid gland may
reveal bruits.
• Treatment options are antithyroid medications, radioactive iodine therapy, and subtotal
thyroidectomy.
Thyrotoxic Crisis
• Thyrotoxic crisis, also known as thyroid storm, is an acute, rare condition in which all
hyperthyroid manifestations are heightened.
HYPOTHYROIDISM
• Hypothyroidism is one of most common medical disorders.
• This condition may be primary (related to destruction of thyroid tissue or defective hormone
synthesis), or secondary (related to pituitary disease with decreased TSH secretion or
hypothalamic dysfunction with decreased thyrotropin-releasing hormone [TRH] secretion).
• In areas with adequate iodine intake, the most common cause is thyroid gland atrophy (end
result of Hashimoto’s thyroiditis and Graves’ disease).
• Manifestations include fatigue, lethargy, personality and mental changes, decreased cardiac
output, anemia, and constipation.
• Patient teaching is imperative, and the need for lifelong drug therapy is stressed.
HYPERPARATHYROIDISM
• Hyperparathyroidism involves increased secretion of parathyroid hormone (PTH).
• Continued ambulation, avoidance of immobility, a high fluid intake and moderate calcium
intake are important.
• Several drugs are helpful in lowering calcium levels: bisphosphonates (e.g., alendronate
[Fosamax]) estrogen or progestin therapy, oral phosphate, diuretics, and calcimimetic agents
(e.g., cinacalcet [Sensipar]).
HYPOPARATHYROIDISM
• Hypoparathyroidism is rare, and results from inadequate circulating PTH.
• The most common cause is iatrogenic, due to accidental removal of parathyroid glands or
damage to these glands during neck surgery.
• Sudden decreases in serum calcium cause tetany, which is characterized by tingling of lips,
fingertips, and increased muscle tension with paresthesias and stiffness.
• Painful tonic spasms of smooth and skeletal muscles (extremities and face), and
laryngospasms and a positive Chvostek sign and Trousseau sign are usually present.
• Focus of patient care is to treat tetany, maintain normal serum calcium levels, and prevent
long-term complications. Emergency treatment of tetany requires IV calcium.
• Instruction about lifelong treatment and follow-up care includes monitoring of calcium
levels.
CUSHING SYNDROME
• Cushing syndrome is a spectrum of clinical abnormalities caused by excessive
corticosteroids, particularly glucocorticoids.
• Key signs include centripedal or generalized obesity, “moon facies” (fullness of face),
purplish red striae below the skin surface, hirsutism in women, hypertension, and
unexplained hypokalemia.
• Treatment is dependent on the underlying cause, and includes surgery and drug therapy to
normalize hormone levels.
ADDISON’S DISEASE
• In the patient with Addison’s disease, all three classes of adrenal corticosteroids
(glucocorticoids, mineralocorticoids, and androgens) are reduced.
• Manifestations have a slow onset and include weakness, weight loss, and anorexia.
• Skin hyperpigmentation is seen in sun-exposed areas of body, at pressure points, over joints,
and in palmar creases.
• The treatment is replacement therapy. Hydrocortisone, the most commonly used form of
replacement therapy, has both glucocorticoid and mineralocorticoid properties. During times
of stress, glucocorticoid dosage is increased to prevent addisonian crisis.
Addisonian Crisis
• Patients with Addison’s disease are at risk for an acute adrenal insufficiency (addisonian
crisis), a life-threatening emergency caused by insufficient or sudden decrease in
adrenocortical hormones.
• Therapy is reserved for diseases in which there is a risk of death or permanent loss of
function, and conditions in which short-term therapy is likely to produce remission or
recovery.
• The danger of abrupt cessation of corticosteroid therapy must be emphasized to patients and
significant others.
• Corticosteroids taken longer than 1 week will suppress adrenal production and oral
corticosteroids should be tapered.
• Nurses must ensure that increased doses of corticosteroids are prescribed in acute care or
home care situations with increased physical or emotional stress.
HYPERALDOSTERONISM
• Hyperaldosteronism is characterized by excessive aldosterone secretion commonly caused
by small solitary adrenocortical adenoma.
• The main effects are sodium retention and potassium and hydrogen ion excretion.
• Patients with bilateral adrenal hyperplasia are treated with drugs. Calcium channel blockers
may be used to control BP.
PHEOCHROMOCYTOMA
• Pheochromocytoma is a rare condition characterized by an adrenal medulla tumor that
produces excessive catecholamines (epinephrine, norepinephrine).